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Use BLUE or BLACK Ink
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j Permit ~I ILD p
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My of Eapo 4 5~ • a
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 ~ Date Received:
Eagan ~4 Al
Phone: (851) 675-5675
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Fax: (651) 675-5694 1 Staff..
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3 - site Address: is 1 ! 19, 131
Name: Yz- 4zn_~s____ Phone: (V-2- 72, - S a~
Resident/
"Owner Address / City / Zip:
Applicant is: _ Owner Contractor
Description of work:
Remo F n -
T Kleof Work
Construction Cor, `'?.l_& C5 Multi-Family Building: (Yes No
Company: C PJI'3 VC Contact: 2~f en
%_.1 1LJ
ContractOr Address: City: ~ ~IaRA~Jfc~.s
State: ML Zip: Phone: mac? ZS -
License SC - 210 6 2- Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
-Yes --No if yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer $ Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public informatVon. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the Clty to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 48 hairs
before you intend to dig to receive locates of underground utilities. www.uoohen3tate2ne0ll.or_Q
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Applica s Signature 49
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